Pat Croskerry, of the Critical Thinking Program, Division of Medical Education, Dalhousie University, Canada, asks us to imagine we have moved to a new town and we need to find a doctor for our child with a previously diagnosed heart problem. What qualities in that doctor would we look for? Likeable personality, good listener, knowledgeable, good communicator, team player, empathetic, good decision maker, professional manner, strong ethical values ..? Imagine if we could only select two qualities, which would they be?Although the qualities listed are all important, Croskerry says that most of us would probably opt for someone who was both knowledgeable and a good decision maker. These two seem to provide the absolute basic requirement for someone who is going to give you the best chance of having your family members correctly diagnosed and appropriately managed. He goes on to say, 'For graduates of accredited medical schools, we can reasonably assume their knowledge base is sufficient. Most schools cover the fundamentals and examine their graduates for competence at stages along the way. Graduates will have been required to pass exams that exhaustively test their knowledge. Further, they will have access to various online resources that provide access to the best, up-to-date medical evidence. But what guarantee would you have that you have also selected a good decision maker, someone who has been trained to reason effectively and make the best decisions? The answer, unfortunately, is that you would have none. Few, if any, medical schools offer a comprehensive course in decision making. Excellent material is available, but basic instruction about intuitive decision making is virtually non-existent. This lack is worrying because psychologists tell us that we make most of out decisions intuitively. Unless something about the medical mind is different, the sad truth is that we are not explicitly teaching doctors the properties of thinking and the decision making that goes with it. To put it bluntly, we are seriously short changing trainees in, arguably their most critical skill, how to make safe and reliable decisions.'From Croskerry P. Clinical Decision Making. In: Barach et al [Eds]. Pediatric and Congenital Cardiac Care: vol 2: Quality Improvement and Patient Safety. Springer-Verlag, London, 2015.

Would be interested to know what your thoughts are on how much a clinician (at any level) can be taught to 'think'. Is it really about being taught how to think, or is it about learning to apply knowledge through experience, whilst retaining an 'open mind'?

Understanding of the limitations of human performance and knowing that so many cognitive biases exist is a helpful starter, but there is some evidence that 'thinking about thinking' can be taught - however, I am awaiting more info on that from an expert Pat Croskerry who is writing a chapter by that name for our forthcoming 'ABC of Clinical Reasoning'!